What is the treatment for bacterial vaginosis (BV)?

From the Guidelines

Bacterial vaginosis should be treated with oral metronidazole 500 mg twice daily for 7 days as the first-line treatment. This recommendation is based on the guidelines provided by the Centers for Disease Control and Prevention 1. Alternative options include metronidazole gel 0.75% applied intravaginally once daily for 5 days, or clindamycin cream 2% applied intravaginally at bedtime for 7 days. For women who cannot tolerate metronidazole, oral clindamycin 300 mg twice daily for 7 days is recommended.

Key Considerations

• Treatment is important even if symptoms are mild because bacterial vaginosis increases the risk of acquiring sexually transmitted infections and can lead to complications in pregnant women.
• The condition occurs when the normal vaginal flora, dominated by Lactobacillus species, is disrupted and replaced by an overgrowth of anaerobic bacteria.
• After treatment, about 30% of women experience recurrence within 3 months, so maintaining vaginal health through avoiding douching, limiting sexual partners, and using condoms may help prevent recurrence.
• If recurrences are frequent, extended or periodic antibiotic regimens may be necessary, as suggested by studies 1.

Treatment Regimens

• Metronidazole 500 mg orally twice a day for 7 days
• Metronidazole gel 0.75% applied intravaginally once daily for 5 days
• Clindamycin cream 2% applied intravaginally at bedtime for 7 days
• Alternative regimens include metronidazole 2 g orally in a single dose, clindamycin 300 mg orally twice a day for 7 days, or metronidazole gel 0.75% applied intravaginally twice a day for 5 days, as outlined in the guidelines 1.

From the FDA Drug Label

Tinidazole is indicated for the treatment of bacterial vaginosis (formerly referred to as Haemophilus vaginitis, Gardnerella vaginitis, nonspecific vaginitis, or anaerobic vaginosis) in adult women [see Use in Specific Populations ( 8.1) and Clinical Studies ( 14.5)]. In patients with all four Amsel's criteria and with a baseline Nugent score ≥4, tinidazole oral tablets given as either 2 g once daily for 2 days or 1 g once daily for 5 days demonstrated superior efficacy over placebo tablets as measured by therapeutic cure, clinical cure, and a microbiologic cure.

The treatment for bacterial vaginosis (BV) is tinidazole given as either:

• 2 g once daily for 2 days
• 1 g once daily for 5 days 2, 2, 2

From the Research

Treatment Options for Bacterial Vaginosis (BV)

The treatment for bacterial vaginosis (BV) typically involves the use of antibiotics, with the goal of relieving symptoms and preventing potential complications. The following treatment options are recommended:

• Oral metronidazole (500 mg twice daily for 7 days) 3, 4, 5
• Clindamycin vaginal cream (2%, once daily for 7 days) 3, 4, 6
• Metronidazole vaginal gel (0.75%, twice daily for 5 days) 3, 4
• Oral clindamycin (300 mg twice daily for 7 days) 4

Treatment for Pregnant Women

For pregnant women, the treatment of BV is crucial to prevent potential complications, such as preterm birth. The recommended treatment for pregnant women with BV is:

• Oral metronidazole (250 mg three times a day for 7 days) 3
• Oral metronidazole (500 mg twice daily for 7 days) may also be used, but with caution 4

Treatment for Recurrent BV

For women with recurrent BV, an extended course of metronidazole treatment (500 mg twice daily for 10-14 days) is recommended 7. If this treatment is ineffective, metronidazole vaginal gel 0.75% for 10 days, followed by two times per week for 3-6 months, may be used as an alternate treatment regimen 7.

Alternative Treatments

Other alternative treatments, such as probiotics, vitamin C, and botanical treatments, have shown some promise, but more research is needed to confirm their effectiveness 5, 7. Secnidazole may also be an attractive new option due to its one-time dosing 7.